Surgical Affections of

Respiratory System

MUHAMMAD MUZZAMMAL
ROLL NO #19 (EVENING)
7TH SEMESTER
DVM, FVS, BZU.
 SURGICAL AFFECTIONS OF RESPIRATORY SYSTEM

Anatomy
Nostrils
1. Levator nasolabialis----Blood-supply—Facial artery, Nerve-supply—Facial nerve.
2. Dilatator naris laterali----- Blood-supply—Facial artery, Nerve-supply—Facial nerve.
3. Dilatator naris transversus---Blood-supply—Palato-labial artery, Nerve-supply—Facial nerve.
4. Dilatator naris superior------ Blood-supply—Facial artery, Nerve-supply—Facial nerve.
5. Dilatator naris inferior------ Blood-supply—Facial artery, Nerve-supply—Facial nerve.
The Hyoid Muscles
1. Mylohyoideus----Blood-supply—Sublingual artery, nerve supply—Mylohyoid branch of
mandibular nerve
2. Stylo-hyoideus---- Blood supply—External carotid artery, Nerve supply—Facial nerve (stylo-
hyoid branch).
3. Occipitohyoideus---- Blood-supply—Occipital artery, Nerve-supply—Facial nerve.
4. Genio-hyoideus---- Blood-supply---Sublingual artery, Nerve-supply—Hypoglossal nerve.
5. Kerato-hyoideus---- Blood-supply—Lingual artery, Nerve supply—Glosso-pharyngeal
nerve.
6. Hyoideus Transversus---- Blood-supply—Lingual artery, Nerve-supply—Glosso-
pharyngeal nerve.
7. Sterno-thyro-hyoideus
8. Omo-hyoideus.
Neck Muscles
Ventral Muscles
1. Panniculus carnosus—The cervical panniculus
2. Sterno-cephalicus--- Blood-supply---Carotid artery, Nerve-supply---Ventral branches of
spinal accessory and 1st cervical nerves.
3. Mastoido-humeralis---- Blood-supply—Inferior cervical, carotid & vertebral arteries.
Nerve supply—Spinal accessory and cervical nerves.
4. Sterno-thyro-hyoideus ---Blood-supply—Carotid artery, Nerve-supply—Ventral branch
of 1st cervical nerve.
5. Omo-hyoideus---- Blood-supply—Carotid and inferior cervical arteries, Nerve-supply—
Ventral branches of the cervical nerves
6. Scalenus------ Blood-supply—Carotid, vertebral, and inferior cervical arteries, Nerve-
supply—Ventral branches of the cervical nerves.
7. Rectus capitis anterior major------ Blood supply—Carotid, vertebral, and occipital arteries,
Nerve-supply—Ventral branches of the cervical nerves.
8. Rectus capitis anterior minor---- Blood supply—Occipital artery, Nerve-supply—Ventral
branch of the first cervical nerve.
9. Rectus capitis lateralis------ Blood supply—Occipital artery, Nerve-supply—Ventral branch
of the first cervical nerve.
10. Longus colli----- Blood-supply—Subcostal and vertebral arteries, Nerve-supply -----
Ventral branches of the spinal nerves.
11. Intertransversales colli------ Blood-supply—vertebral artery, Nerve-supply—The cervical
nerves.
The Nasal Cavity
Blood-supply—Palato-labial, superior labial, and lateral nasal arteries.
Nerve-supply—Trigeminal and facial nerves.

Larynx
Blood----supply—Thyro-laryngeal artery
Nerve-supply—Superior laryngeal and recurrent laryngeal nerves (from vagus).

Laryngeal Extrinsic Muscles

1. Sterno-thyro-hyoideus ---Blood-supply—Carotid artery, Nerve-supply—Ventral branch of
1st cervical nerve.
2. The thyro-hyoideus
3. The hyo-epiglotticus
Intrinsic Muscles
1. The crico-thyroideus
2. The crico-arytenoideus dorsalis s. posterior
3. The crico-arytenoideus lateralis
4. The arytenoideus transversus
5. The thyro-arytenoideus

Trachea
Blood-supply—Common carotid arteries,
Nerve supply—Vagus and sympathetic nerves.
Lungs
Vasculature
1. Branches of pulmonary artery.
2. Pulmonary veins.
3. The bronchial arteries
4. The esophageal artery.
5. Lymph vessels are numerous; deep set accompanies bronchi and pulmonary vessels.

Nerve Supply
The pulmonary nerves from vagus and sympathetic nerves. Enter at the hilus and supply
branches to the bronchial arteries and air-tubes.
 Surgical Affections
Atheroma
 An atheroma is a subcutaneous cyst that
develops in caudal portion of false nostrils of
horse.
 It occurs b/w mucus memb of false nostrils
deeply and the skin superficially.
 Unilateral or bilateral.
 Varies in size from small pigeon egg to tennis
ball
 Contents vary, frequently thick, oily, grey
material.
 Smaller don’t interfere with vital functions but
larger ones.
Surgical Rx
 Animal recumbent with affected side upwards
 Surgical preparation of area over cyst and 15cm2 around it.
 S-shaped incision through skin and it will expose wall of cyst
 It is difficult to resect cyst lining from surrounding tissue and extreme care must be
taken not to cut through cyst wall.
 If cyst can be removed in its entirety, skin closed with on absorbable suture i.e. 0-0
nylon, using interrupted horizontal mattress pattern.
If cyst wall has been punctured, drainage is important so skin incision can heal.

Nasal Polyps
 Occur frequently in horses but rare in cattle.
 Originate from mucus memb of lining of nasal cavity and most commonly attached on
lateral wall but occasionally on nasal septum i.e. caudally.
 Occasionally originate from alveolus of teeth and may have tooth material in it.
 Variable in size may completely occlude nasal cavity, which causes foul odor.
Rx
 It is necessary to trephine nasal cavity to get to attachment of polyp.
 Cast animal with affected side upwards, prepare surgical site including area over
lateral frontal and facial bones
 Trephine opening to be 2.5cm caudal to infraorbital foramen and 1cm to medial
plane.
 Diameter of opening be 2.5 cm for easy accessibility and to avoid cutting into nasal
septum
 As nasal cavity is entered, insert the finger and pull polyp through external nares
slightly.
 Determine site of attachment and simply cut it from mucus memb.
 Resection of Nasal Septum

 It is indicated when there is necrosis of

nasal septum, tumors associated with
septum or when it becomes thicker to a
point when it interferes with normal
respiration.
 Necrosis may be 2ndry to fracture of
septum
Dx
Dx can be made in several ways:
1. By listening to animal respire
2. By detecting foul odor coming from one or
both nostrils & by use of rhinolaryngeoscope.
Rx
 Anesthetize the animal and cast in lateral recumbency.
 Prepare surgical site on top of facial bones and on each side of head down to ventrum of
maxillary sinuses.
 Also prepare site over trachea for tracheostomy, in event it becomes necessary as a
result of abundant hemorrhages ensuing post-surgically.
 If Dx is +ve, trephine opening is made @ caudal border of diseased nasal septum.
 Area is located by passing thumb and fore-finger from cranial to caudal along nasal bone
& about 2.5cm caudal to where nasal bone starts diverging directly on mid-line is the
site.
 An opening of 2.5cm diameter is made through skin+ subcut.
 Remove skin and fascia, expose the periosteum.
 A 2.5cm trephine opening is made @ median line through nasal bone down to mucus
memb.
 Mucus membrane is cut b4 entering nasal cavity.
 A heavy Rochester compression forceps is applied dorsoventrally on nasal septum.
Rx
 Determine extent of damage to tissue & amount of tissue to be removed through the
trephine opening and exploration through external nares
 Pass a guarded chisel through external nares @ an area sufficient to remove all diseased
tissue.
 Chisel is directed to cut nasal septum as it attaches to nasal bone dorsally, incision carried
caudally until chisel meets forceps running dorsoventrally.
 Make a similar incision on floor of nasal cavity, cutting entire nasal septum on its
attachment @ vomer bone
 A small chisel is passed through trephine opening to cranially and caudally transect nasal
septum dorsoventrally
 Remove resected nasal septum, don’t remove entire length septum as it supports nasal
bone.
 Hemorrhages can be controlled by electro cauterizer and suction apparatus
 Conjugated E2 45 min prior to surgery helps to control hemorrhage
Sinusitis
It is the inflammation of the sinuses i.e. paranasal sinuses.
4 pairs of para nasal sinuses include:
 Maxillary
 Frontal
 Spheno-palatine
 Ethmoid
Dx
it is based on:
 Unilateral swelling of affected sinus with discharge from respective nostril
 Dull sound on bone percussion, indicating fluid in the sinuses
 Constriction of nasal-lacrimal duct causing unilateral lacrimation
 Radiograph
 Tapping area with1/8 inch intramedullary pin & subsequent aspiration by syringe
Sinuses Anatomy
Rx
 Trephination of sinuses.
 Trephine opening of diameter 2.5cm
 If more than one sinus is involved larger surgery is performed
 Drainage of sinuses
 Flushing wound with 1:1000 KMnO4 or nitrofurazone until infection is cleared
Progressive Ethmoidal Hematoma
This condition can affect turbinates or sinuses or the both. Lesions resemble neoplasm. It is
characterized by thin fibrous wall enclosing fluid filled pocket having blood, macrophages,
giant cells and hemosiderin.

C. Signs:
1. Serosanguinous nasal discharge
2. Respiratory dyspnea may be present
3. Odor is foul if lesions are larger.
Dx
1. Endoscopy
2. Biopsy
3. Radiography

Procedure
 A flap is constructed in caudal aspect of
frontal sinus
 Turbinate area of frontal sinus is opened
to expose ethmoidal sinus subsequently
ethmoidal hematomas
 Blunt dissection to free the lesions from
attachment
 Hemorrhage controlled by packing and
aspiration
Turbinates and Meatuses
Tracheostomy/Tracheotomy
It is an emergency procedure. The
tracheal anatomy should be under-
stood to a practitioner.
Indications
1. URT obstruction
2. Tumors
3. Fractured trachea
4. Compressed tracheal rings
5. Loss of laryngeal muscles
6. Snake bite
7. To approach larynx or pharynx
Procedure
1. Usually in obstruction, there’s no time to prepare site aseptically but in other cases is.
2. Area chosen, be away from mandible and thoracic inlet but must provide practitioner with
good tracheal exposure
3. Tracheostomy for pharyngeal or laryngeal approach must be performed more distally in
cervical area
4. 1cm long and 5cm wide area parallel to trachea is anesthetized S/C i.e. 20-gauge needle.
7.5cm long incision through skin and fascia
5. Dissection of Sternothyroideus or sternocephalicus muscle
6. Approach the trachea
7. Stab incision in transverse fashion in b/w C-shaped cartilaginous rings.
8. Manual manipulation can be done.
9. For prolonged tracheostomy, elliptical incision given @ proximal and distal to cartilaginous
ring
10. Endotracheal intubation may be done, fixed by adhesive tape in place/suture it with skin.
Guttural Pouches
GPs are unique to small number of animals spp, including horse. They are sacs of air that
expand from the Eustachian tube, with one on each side of the horse's head. They are
positioned beneath the ear and each GP cavity in an adult horse can hold as much as a coffee
mug i.e. 300-500ml.

Function
1. Their anatomical association with the URT suggests that horse's GPs might function during
selective brain-cooling to maintain blood carried by internal carotid arteries (ICA) at a
temperature below core temperature during hyperthermia.
2. Have ability to protect horse from ear infection
3. Trap bacteria entering eustachian tube
2, Clear foreign bodies
Igs in GP
• IgGa, IgM, IgA
Guttural Pouch Anatomy
GP Empyema
It is the infection of GP 2ndry to infection+inflammation of pharynx with an ascending
infection of eustachian tube infecting GP, leading to accumulation of pus in GP.
• It is usually unilateral and is 2ndry to bacterial infection particularly to strangles

C. Signs
1. Animal has difficulty in swallowing 2. Pus drains from nostrils
3. Distention of affected side of neck 4. Tenderness over the area
5. On deep palpation mucopurulent discharge from affected side

Chondroids
If the pus after infection has been retained in GP for long time, most of the fluid drains and
inspissated portion remains. The concentrates left called chondroids.
GP Tympanitis
o It is usually observed in young foal up to 18 mo of age. It is congenital deformity &
usually occurs unilaterally.
o Air enters GP during expiration or when animal swallows or cough, air is retained in
GP causing tympany accompanying mild infection.

C. Signs
1. Distention of involved side but no pain, resonant on percussion
2. Stertorous breathing
3. Difficult swallowing while eating
GP Mycosis
 Fungal infection of GP, usually unilateral, rarely bilateral
 Occurs in immunosuppressed horses, due to long term anti-biotic therapy
 Usually due to Aspergillus spp
C. Signs
1. Unilateral/bilateral epistaxis 7. Dysphagia
2. Affected area is warmer 8. Exercise intolerance
3. Dyspnea, Cough, polypnea 9. Prolapse of 3rd eyelid
4. Cervical pain 10. Ingesta in nasal passage
5. Head shaking 11. Snoring
6. Extended neck, ears drooping 12. Hyperhidrosis
Dx
1. Diphtheric membrane 2. Epistaxis
3. Culture, cytology 4. Horner’s syndrome
5. Radiograph 6. Partially fluid filled
7. Bony exostosis 8. Osteolysis of stylohyoid bone
Approaches for GP
Hyovertebrotomy
 10cm long incision i.e. 2cm cranial and parallel to wing of atlas
 Parotid salivary gland and parotid-auricularis
muscle exposed
 Retract parotid gland cranially
 This leads to Occipitohyoideus & digastricus
muscle craniodorsally & rectus capitis
cranialis muscle caudo-dorsally------blunt
dissection.
 Expose dorsolateral wall of GP
 Puncture GP using scissors, enlarge the
opening
 Deal with respective case
 Viborg’s Triangle Approach
GP bordered by:
 Tendon of sternocephalicus (dorsally)
 Linguofacial vein (ventrally)
 Vertical ramus of mandible (rostrally)

• 4-6cm incision dorsal & ll to linguofacial vein

@ border of mandible
• Retract base of parotid gland dorsally, GP
exposed
•Further incise and manipulate.
 White House Approach (WH)

 Animal in dorsal recumbency

 Incision on ventral mid-line of larynx
 Dissection b/w paired sternohyoideous,
omohyoideus and along larynx to GP
 GP opened medial to stylohyoid bone
 Modified White House Approach
(MWH)

 Incision along ventral aspect of

linguofacial vein.
 Extend rostrally 12cm from jugular vein
 Expose lateral aspect of larynx by
dissecting fascia
 Blunt dissection until GP appears.
Advantages of WH & MWH
They allow direct access to:
1. Roof of GP
2. Digital exploration lateral compartment
3. Excellent ventral drainage
4. Simultaneous access to both the pouches
Suturing
1. Suture GP with simple interrupted suture pattern i.e. polyglactin 910
2. Appose fascia associated with parotid gland

Cleft Palate
It is usually associated with GIT, it also involves RT bcz of fact that when soft palate is
cleft, respiratory infections ensue. Signs note immediately after birth as milk runs out of
nostrils and dried crest of milk and mucus on nostrils. Most important sequel is
pneumonia.
Anatomy of Soft Palate-----cpr
C. Signs
1. Rough hair 2. Pneumonia
3. Raspiness as animal breathes

Approach
Mandibular Symphysiotomy
• Prepare the site
• Wash mouth thoroughly to remove any food
• General anesthesia as well as atropine to avoid laryngeal spasm
• Intubation by tracheostomy
• Incision @ level of Mandibular curvature along mid-line up to lip area
• Carry incision through mentalis muscle to symphysis
• Incise gingival and lip’s mucus membrane
• Deepen incision through mylohyoideus muscle
• Mandibular L.N exposed separated on midline by blunt dissection to mylohyoideus near
lingual process
• Mandibles separated now by Osteotome or Gigli bone wire, it exposes geniohyoideus
and genioglossus muscles, which are severed @ 2.5cm from attachment to mandible i.e.
incision is lateral to both said muscles and b/w mandibles
• Now separation can be done easily with scissors
• Mucus membrane of mouth now cut from cranial to caudal end to separate mandible to
visualize defect further
• Mandibulo-temporal joint is luxated, it exposes the palate and pharyngeal area
completely.
• Repair the cleft in the palate, the extent of lesion must be determined 1st.

Closure/Suturing
Cleft ends i.e.
1. Muscle portion—0-0 polypropylene
2. Mucus memb---0-0 polyglycolic acid
 Suturing

 when suturing cleft don’t use scissors, & use #3 Brad Parker with long handle having #10
blade.
 Lateral incisions not sutured and left for granulation
 When closing suture line, entire area is sprayed with organic iodine disinfectant
 Oral mucosa----1st closed-------caudal to cranial------polyglycolic acid/polyglactin,
continuous horizontal mattress sutures
 Both the mandibles repositioned, oral mucosa sutures continued cranially for one-half
distance
 Suture left in place until rest of tissue is reconstructed.
 Loose C.T---No.1 polyglycolic acid/polyglactin
 After this suture, a Penrose tube left in deep suture line for post-operative flushing
 Teeth & mandibles are wired using 20-gauge stainless steel wire
 Suturing
 Close oral mucosa & closure completed in oral cavity
 Geniohyoideus+genioglossus--- No.1 polyglycolic acid/polyglactin----horizontal
mattress.
 Mylohyoideus with fascia--- 0-0 polyglycolic acid/polyglactin
 S/C fascia--- No.1 polyglycolic acid/polyglactin----simple continuous
 Skin---No.0 nylon or medium vetafil
 B4 closing skin, further fixation of mandibles by placing cortical screw just caudal to
symphysis
 In older foals, further fixation with 20-gauge wire in 8-shape with threaded nut and
washer around head of screw.
Anatomy of Hyoid Bone & Structures to be Considered for CPR
Laryngeal Hemiplegia (Roaring)
It is characterized by inspiratory dyspnea due to inadequate dilatation of larynx that results
from relaxation and atrophy of intrinsic laryngeal muscles. These muscles innervated by
recurrent laryngeal nerve, a branch of vagus nerve i.e. malfunction may be due to trauma,
infection, Pb & other heavy metal poisoning, toxicosis and pathological stretching of this
nerve.

C. Signs
1. Exercise intolerance 3. Roaring sounds
2. Dyspnea 4. Head flexed towards affected side

Dx
1. Tracheal palpation 2. Percussion
3. Head inspection 4. Any abnormal discharge
5. Radiography 6. Biopsy
7. Endoscopy immediately b4 and after exercise 8. Rhinolaryngeoscopic examination
Approaches
1. Laryngeal ventriculectomy
2. Ventricuar cordectomy
3. Vocal cordectomy
4. Cleft palate resection
5. Arytenoidectomy
6. Attempts to reconstruct nerve supply
to intrinsic muscles
Larynx
Larynx (Intrinsic muscles)
Larynx (Extrinsic muscles)
1. Laryngeal Ventriculectomy
 It ‘ii not return arytenoid cartilage to normal location but can be applied if cartilage is
paralyzed and don’t dilate on inspiration
 Dorsal recumbency/standing surgery
 Atropine to avoid laryngeal spasm
 Site---6th tracheal ring to 15cm cranial to laryngeal apparatus & laterally to lateral
aspect of masseter muscle
 Incision through skin and fascia from 1st tracheal ring to cranial aspect of larynx
 Palpate cricothyroid cartilage, with triangle directed cranially
 Sternothyroideus muscle is separated bluntly down on mid-line to cricothyroid cartilage
 Cricothyroid notch important to be located i.e. bounded
1. Cranially---Thyroid cartilage
2. Laterally---wings of cricoid cartilage
3. Caudally---Cricoid cartilage
 Introduce laryngeal burr into affected saccule and engage it into mucus memb.
 Laryngeal saccule is clamped in jaws of 20cm long forceps
 A curved scissors is passed and mucus memb is excised
 Withdraw piece of mucus memb and observe if enough of it is removed
 Don’t hurt the cartilage-----chondritis and remove 2nd saccule in the same way
 Excess soft palate must be trimmed off i.e. if come to incision site

Complication
In an unsuccessful surgery, if arytenoid cartilage is collapses into larynx i.e. due to paralysis
or atrophy of cricoarytenoideus dorsalis muscle and the aim to reposition arytenoid
cartilage in normal position i.e. done by embedding prosthetic device from cricoid
cartilage to muscular process of arytenoid cartilage, thus positioning collapsed cartilage in
dilated position

• Suture material mersilene No. 2/5mostly chosen.

Laryngeoplasty
 Animal is cast in lateral recumbency
 Area including from ear to side of neck to side of face to side of eye, prepared.
 15 cm incision 1cm ventral to linguofacial vein from laryngeal cranial part to 3rd tracheal
ring
 Deeper dissection towards larynx and superficial to omohyoideus muscle is done
 Caudal end of cricoid cartilage is palpated and by blunt dissection, it is exposed
 A half circle No.2, trocar point needle or No.2 Martin’s uterine needle threaded with
mersilene prosthesis is introduced into caudal border of cricoid cartilage
 It is placed just deep to cartilage not through mucus memb of larynx
 Needle is directed cranially to come out 1cm away from site of penetration, 1cm lateral to
medial ridge of cricoid cartilage
 Needle is directed to line where it ‘ll penetrate through cricoid cartilage in line with
muscular process of arytenoid cartilage
 Needle is pushed through lamina of cricoid cartilage through cricopharyngeous back to
the incision site. Several stitches given to the both together.
Securing Mersilene Sutures
One of 2 techs can be used to secure mersilene in muscular process: -
• 1st is taking needle & passing it backhanded into muscular process over thyroid cartilage.
• 2nd by means of 14-gauge needle to drill hole through muscular process in cranial medial
direction. 25-gauge wire is doubled fixed in needle, which prevents needle from cutting
cartilage and prevents subsequent passage of wire. As hole is drilled needle is passed into
soft tissue @ medial aspect of muscular process & drawn to lateral side. With looped end of
wire leading suture can be placed into loop and drawn around muscular process then leader
& trailer tightened.
Arytenoidectomy
It is surgical removal of arytenoid cartilage
Indications
 Failure of laryngoplasty
 Chondritis, chondroma
 Muscular process fracture.
Clinical signs are same as of laryngeal hemiplegia.

Dx
1. External palpation 3. Endoscopy
2. Radiography 4. Irregular tags and projections of affected cartilage

Procedure
• Subtotal/Partial Arytenoidectomy
• Procedure is almost same as that of laryngoplasty except the arytenoid cartilage is to
cut not re-positioned. Arytenoid cartilage is cut @ junction of corniculate cartilage and
further elevated the hyaline portion of cartilage, as elevated blunt dissection is done to
relieve it from surrounding tissue.
• Muscular process and articular facet left in place or cut if necessary.
• Mucus memb closed with 0-0 polyglactin or polyglycolic acid